Taiwan should gain WHO status

By W. Andy Knight

There have been 64 cases of enterovirus 71 (hand, foot and mouth) infection in Taiwan this year, resulting in two deaths. This current outbreak is reminiscent of a similar one in 1998 that killed 78 Taiwanese. In China, 4,500 people have been infected by this virus and 22 of them have died, Chinese government announcements have said.

This situation is a chilling reminder of the need for prompt action to prevent the spread of such diseases. Transnational epidemiological outbreaks do not respect borders and therefore require the intervention of a global health system to stem their spread.

Since China has persistently and irrationally used its “one China” policy to block Taiwan’s bid to become a member of the WHO, when a global emergency response is required to arrest an epidemic in Taiwan, it is generally much too slow in coming. In the case of the 1998 outbreak, it took an appeal from the US Centers for Disease Control and Prevention to nudge the WHO into action in Taiwan.

We all remember the big scare of early 2003 when, within a matter of a few months, a transboundary airborne disease that had struck Guangdong Province in November 2002 quickly spread to Hong Kong and then to Taiwan and other countries. It took more than two months after the SARS outbreak for the WHO to dispatch health experts to Taiwan simply because Taiwan, as a non-member of the WHO, did not have a direct channel for communicating data to the world health body about the outbreak.

Once SARS started to spread across the Pacific Ocean to North America, the WHO slapped unprecedented travel advisories on China, Hong Kong, Taiwan and Toronto, Canada. Within weeks, airline traffic to affected areas dropped more than 50 percent and hotel occupancy in most Asian countries plummeted by more than half.

This epidemic took a major economic toll on East and South Asian economies, estimated at some US$18 billion in nominal GDP terms for 2003 — or about US$2 million per person infected by SARS.

Taiwan is also vulnerable to the spread of the H5N1 strain of avian flu. Of the 378 reported cases of avian flu globally, 80 percent were in six countries — China, Indonesia, Vietnam, Thailand, Cambodia, and Laos. Taiwan’s proximity to those countries, in addition to the frequency of airline travel between them and Taiwan, puts this country at great risk of an outbreak of this disease.

The outbreaks of SARS, avian flu and enterovirus 71 highlight just how damaging unexpected, and seemingly uncontrolled, transnational health threats can be in our globalized world. Since such diseases have no boundaries, the outbreaks also reveal the importance of ensuring that no gap or weak spot exists in our global village’s disease prevention network.

There is a weak spot in the global disease prevention network because Taiwan is not a member of the WHO. Taiwan, whose status as a de jure sovereign state has been in question since 1971, has been unable to attain WHO membership.

If there is a time to make the case for Taiwan’s membership in the global health regime, it is now. With the incoming Chinese Nationalist Party (KMT) government planning to significantly increase cross-strait direct charter flights between China and Taiwan, the calls for Taiwan to become a member of the WHO will become louder.

There is no reason why Taiwan should not be invited to become a full-fledged member of the WHO. But failing that, it ought to be considered, at the very least, for observer status in the World Health Assembly (WHA).